I have prescription drug coverage through a current or former employer or a union, should I look at other coverage? Medicare will help employers or unions provide retiree drug coverage meeting Medicare’s standards.  Be sure to get written documentation from your employer or union showing how your drug coverage compares to Medicare prescription drug coverage, and how they are intended to work together.  Read materials carefully and fully comprehend what your options are.  You can contact the plans website or contact their office to get answers to questions about your coverage. Q. Will I be required to join a Prescription drug plan? You are not required to join a drug plan; it is optional. If you are need Medicare to help cover costs for your drugs, then joining a Medicare prescription drug is then needed to help pay for your drugs. There are various plans to meet most any need. Even if your prescription drug purchases are infrequent now, consider joining.  Joining when you are first qualified for Medicare coverage insures that you will not have a penalty to pay if you are to join at a later time. If you wait, the premium will be higher when you join because of the late fee penalty. You are able to join a drug plan when you are first eligible for Medicare and if you miss your enrollment period, the next chance will be during the time of November 15th until December 31st of every year.  This will mean a higher premium each month as long as you have Medicare prescription drug coverage. Q. What does a Donut Hole mean? In 2009 it is the gap in Medicare Part D coverage when you have between $2,700 and $6,153.75 in total drug costs in a calendar year.  You will have to pay 100% of the cost for your prescription drugs and Medicare will not help pay for your drug costs during this period unless you qualify for a Low Income Subsidy.

How does Medicare prescription drug coverage work?
Original Medicare or a Supplement will not provide you with the prescription drugs that you needs.  There are two means of getting Medicare drug coverage which are Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage and a Medicare prescription drug plan. Plans will include a premium which will vary depending upon how much coverage they offer; some have deductibles and a coinsurance or copayment.  These plans will help cover the generic and brand-name prescriptions you use now and in the future. 

Why should I get Medicare prescription drug coverage?
Some individuals use extensive medications and now have the opportunity to save on expenses and others take few if any medications.  In both cases a plan is favorable to put into place when you are eligible.  It will give you peace of mind knowing that your expenses in most cases can be reduced.

Do I have any options for paying my Medicare drug plan premiums?
You have many options to pay for Medicare Prescription drug plan premium provided by the insurance carrier.  The premiums could be paid by a credit or debit card, billed each month from the plan, taken out of the person’s Social Security check each month, or deducted from a checking/savings account. With the Social Security payment deduction, you need to call the plan in which you are enrolled in, not Social Security. It is sort of like direct deposit, it may take up to 3 months to start and they may even take 3 months worth of premiums at once. A delay in premiums being held may be seen if you switch or leave any plans.

Can I get support to help me choose a Medicare prescription drug plan?
Receiving support is very helpful when trying to make a decision about a Medicare prescription drug plan. Contacting a member of your family or a close friend, a caregiver or an insurance agent can also assist you in making a decision.  Other areas of support can be the tool Medicare provides to give you detailed plan information at Medicare Prescription Drug Plan Finder or by calling 1-800 MEDICARE (1-800-633-4227) TTY 1-877-486-2048.  Also companies will be advertising their plan choices by mail, on television and in your local newspaper. 

Will Medicare prescription drug plans (PDP) have preferred drug formulary?
All of the private insurance companies offering a PDP will have a preferred drug list.  This is a specific list of drugs that the  plan has selected to control cost and will be as effective as other drugs.

How does the Medicare a PDP work?
Each Medicare PDP will include generic and brand-name drugs that will be categorized into tiers that determine the rate paid by the insurance company and you, if applicable.  The company generally classifies the drug into a formulary, which is simply a list of drugs covered by the plan which adheres to Medicare's requirements.  If you need a drug that isn't on the list, or if one of your drugs is being removed from the list, you or your physician can appeal the decision.  Also, the insurance company will must let you know approximately 60 days prior to  a drug being removed from the list or if the costs are changing.

Are some of my drugs covered under Part B?
Each Medicare PDP will include generic and brand-name drugs in a formulary and many of the medications you are already on should be covered.  It is best to determine coverage before you sign up to ensure that you will be able to the majority of your medications at a reduced price. 

What are the enrollment periods for Prescription Drug Program?
You are eligible to join a Medicare Prescription Drug Plan when your turn 65 and can elect to change prescription drug insurance companies and/or plan from November 15 through December 31 of every year for the next calendar year.  There are exceptions to this rule such as switching your plan if you move or enter a nursing home, and if you have both Medicare and Medicaid, you can change plans at any time.

Are the medications that I am using be covered?
In general, every Medicare Prescription Drug Plan must include at least two drugs in every drug category.  Medicare provides a great tool to look up detailed plan information at Medicare Prescription Drug Plan Finder or contact the provider.  Before hand, make a list of all your current drugs including dosage, frequency and current monthly costs.  Be sure to also determine if your favorite local pharmacy is in-network

Will happens if one of my drugs needs "prior authorization?"
In some cases a medication will need a prior authorization and you can have your doctor can complete and submit a form to the insurance company.  Once they receive the form they will determine the benefit and provide you with an answer within 72 hours (24 hours to expedite request).  If approved, your medication will be covered the for at least the remainder of the plan year, providing you remain enrolled in the plan, the doctor still prescribes the drug for you, and the drug is safe and approved as an effective way  to treat your illness or condition. If the plan denies your exception request, you have the right to appeal.

What can I do if my medication isn’t on my plan’s formulary?
If the case should arise that your drug isn’t on the plan’s formulary your doctor must provide a statement that entails that this specific medication is required and or necessary to treat any condition you might have. If you have a prescription for a drug that is not on the list, have your doctor or physician look over the formulary to see if there might be another drug that can be just as effective. Ask your plan which information would be most beneficial to process your request for an exception.

Should I check my medications in the Medicare Prescription Drug Plan Finder?
Yes, it is the best way to determine coverage and costs.  Medicare provides a great tool to look up detailed plan information at Medicare Prescription Drug Plan Finder.  Pull your list together before you enter your medications and the tool will indicate if the drug name that you entered is a Brand name, Generic, or Over-the-Counter drug. 

Why is it best to use my Zip Code in the Medicare Prescription Drug Plan Finder?
By using your zip code in the tool it will allow you to see what the cost is in your geographic region.

If I am outside of the U.S. will Medicare cover my medical expenses?
Medicare is a United States insurance provider that provides protection against hospital and medical expenses, therefore if you are to travel outside of the countries perimeters you generally cannot benefit from Medicare. If you plan to be out of the US for a long period of time, you may wish to enroll during a later general enrollment period or returning after you are eligible for the medical insurance program, you may wish to enroll during your first enrollment period. 

What if I have a limited income and resources?
If you have limited income and resources and can qualify for financial help, Medicare will pay for a large portion of your medication costs.  Contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit www.socialsecurity.gov to discover more information about financial help

Is there a  network while on Medicare?
You generally have see the doctors or medical service providers who have signed a contract with a health coverage plan referred to an in-network when you are on a Health Maintenance Organization (HMO).  If you select any PPO, Preferred Provider Organization or POS, Point of Service plan then you are allowed to see doctors or medical service providers other than plan’s network but it will be more costly.